Vestibular Exam cont Flashcards
List the components of the vestibular exam
- Auditory Screen
- Gaze Stability Assessment
- Cervical Dizziness tests
- Balance and Postural Control Assessment
what tests are performed during the auditory screen?
Weber and Rinne Test
What tests are included in the gaze stability assessment?
- Spontaneous Nystagmus
- Gaze-Evoked Nystagmus
- Optokinetic Nystagmus
- Pursuit
- Saccades
- VOR
- Dynamic Visual Acuity
- Head Impulse Test
- Post Head-Shaking Induced Nystagmus
- Skew Deviation
- VOR Cancellation
what is a spontaneous nystagmus?
onset of nystagmus without any cognitive, visual or vestibular stimulus
occurs in the absence of any purposeful eye or head motion
(you observe nystagmus at rest)
describe a spontaneous peripheral nystagmus
- mixed horizontal/torsional
- fast phases of the horizontal and torsional component move the eyes away from involved ear
- present w/acute lesions, rarely w/chronic stable lesions
- more prominent w/fixation removed
describe a central spontaneous nystagmus
- vertical or torsional
- acute or chronic
- more prominent with fixation present
how is a gaze-evoked nystagmus tested?
head remains still but eyes move side/side and up/down but only in a small range
performed with and w/o visual fixation
describe a gaze-evoked nystagmus that is indicative of a peripheral vestibular dysfunction
- uni-directional
- fast-phase away from involved side (ie it points to the good ear)
- present w/acute lesions, rarely w/chronic stable lesions
- decreases when fixation available
describe a gaze-evoked nystagmus that is indicative of a central vestibular dysfunction
- changes direction
- seen acutely or chronicaly
- increase or stays the same with fixation available
what is alexander’s law?
a peripheral vestibular nystagmus increases in intensity with the gaze directed towards the fast phase
what is a 1st degree nystagmus?
only present when gaze directed towards fast phase
what is a 2nd degree nystagmus?
- present in primary gaze and when gaze directed towards fast phase
- strongest when gaze is directed towards fast phase
what is a 3rd degree nystagmus?
- present in all gazes
- strongest when gaze directed towards fast phase
what is an optokinetic nystagmus?
an involuntary optic reflex for percieving motion in the visual field
normal to have nystagmus during this
what is an abnormal aysmmetrical response for the optokinetic nystagmus?
direction of reduced motion → non-compenstation vestibular condition
you will see a blunted or irregular beating response compared to the other side
define smooth pursuits
ability of eyes to follow a target at a slow pace
this is a voluntary movement
to test → sit with head still and target is brought at a slow pace from L to R
what are saccades? How do you test these?
rapid repositioning between visual targets (voluntary movement)
To Test:
- Pt sits w/head still and 2 targets are placed to R and L fields of vision
- Pt is instructed to move from center point (nose) to L to center then to R target